Introduction

ATHEROSCLEROSIS is a progressive medical condition known to affect arteries. It happens when plaque accumulates in the arteries leading to decreased flow of blood plaque is a fatty deposit. Plaque contains cholesterol, fatty substances, fibrin, calcium and other materials that build up within the inner lining of an artery leading to the artery walls becoming thick and stiff through a process called arteriosclerosis.

It can cause serious complications such as stroke and heart attack.

 

 Key Facts & Statistics

Key facts and statistics that surround artherosclerosis

• Artherosclerosis is the underlying cause of almost one-half of all deaths in western countries.
• It is a very common condition. In accordance with the United States National Institutes of Health, about 50% of individuals aged 45 to 84 years in the USA have atherosclerosis which they are not aware of.
• Heart attacks and strokes, which are complications of of plaque accumulation, are the leading cause of death globally.

 

Risk Factors

What are the risk factors for artherosclerosis?

• Artherosclerosis has several risk factors. Some are modifiable while others are non-modifiable.
• They are:

1. Age and sex. Being older than 45 years for males  and 55 for females.
2. Family history of premature cardiovascular disease.
3. Hypertension (raised blood pressre).
4. Diabetes.
5. Metabolic sndrome.
6. Insufficient physical actiity.
7. Consuming food that has much sugar, trans fat and saturated fat.
8. Consuming tobacco products, for examole smoking cigarettes.
9. Hyperlipidemia.

 

 Causes

What are the causes of artherosclerosis?

• The following are believed to be causes of artherosclerosis:

1. Raised low-density lipoprotein (LDL) cholesterol and triglyceride levels.
2.  Consuming tobacco products.
3. Hypertennsion.
4. Diabetes.

• The above mentioned agents cause damage on to the endothelium leading to commencement of artherosclerosis.

 

Stages

What are the stages of artherosclerosis?

Stage I– the fatty streak stage. Cholesterol and other materials build up on the inner lining of an artery. Often observed in young individuals. It can be found in children as young as 10 years old. It can be reversed through lifestyle modifications such as good diet and regular physical activities such as exercise.

Stage II– the fibrous plaque stage. Plaque starts to accumulate in the walls of the artery. It is irreversible and may need medical intervention in order to prevent progression.

Stage III– complicated plaque stage. The plaque is unstable. It may rupture causing a heart attack or stroke.

Stage IV– end stage. There is complete blockage of the artery. Flow of blood is severely decreased or even blocked completely. It is a life-threatening stage.

 

 Signs & Symptoms

What are the signs and symptoms of artherosclerosis?

The signs and symptoms do it start until the vessel has become very narrow. Most people do not notice that they have an accumulation of plaque within their arteries until they suffer a medical emergency such as a stroke.

The signs and symptoms may become noticeable when the blockage is at 70%. These signs and symptoms depend on the location where the blockage occurred.

Kidneys

• The following may be experienced when the arteries supplying blood to the kidneys become narrowed:

1.  Edema (swollen body tissues due to accumulation if fluid)
2. Drowsiness or tiredness.
3. Headaches.
4. Unexplained or unintended loss of weight.
5. Nausea and vomiting.
6. Markedly elevated blood pressure that is unresponsive to anti-hypertensive agents.

 

Brain

• The usual initial symptoms in carotid artery disease are stroke or transcient ischemic attack. Additionally, the following might be experienced:

1.  Dizziness.
2.  Severe headache.
3. Loss of vision in one eye.
4. Weakness on one body side.
5. Drooping on one side of the face.
6. Slurred speech.

 

Gastrointestinal tract

• In mesenteric ischemia due to inadequate blood supply to parts of the digestive system, the patient may experience:

1.  Unintentional loss of weight.
2. Nausea and vomiting.
3. Diarrhea.
4. Abdominal cramping after eating.

 

Legs and feet

• In peripheral artery disease, there may be:

1. Alterations in skin color (redness).
2. Sores on the feet (they do not heal).
3. Muscle pain.
4. Cool skin on the feet.

 

Heart

• The following may be experienced in coronary artery disease:

1. Dyspnea on performing simple physical activities.
2. Angina.
3. Heart palpitations.
4. Lightheadedness.
5. Fatigue.
6. Pain in theback and shoulders.

 

Types

What are the most common types of artherosclerosis?

• Atherosclerosis can affect any artery within the body. It has a specific name depending on the arteries that are affected:

1.  Carotid artery disease.This is accumulation of plaque within the arteries located in the neck causing a decreased flow of blood to the brain.
2. Coronary artery disease (CAD). plaque build up within the heart arteries.
3. Peripheral artery disease (PAD). plaque accumulates within the arteries in the legs, arms or pelvic area.
4. Renal artery stenosis. Plaque builds up within the arteries that supply blood to the kidneys.
5. Mesenteric artery ischemia. There is accumulation of plaque within arteries that supply blood to the intestines.
6. Vertebral artery disease. This refers to atherosclerosis occurring within the arteries that supply blood to the back of the head.

 

 Diagnostic Procedures  & Tests

How is artherosclerosis diagnosed?

• Review patient’s history- medical and family history along with lifestyle.
• Physical examination.
• Blood tests such as cardiac blood tests to check for cholesterol levels and gather data about functioning of the heart. Other tests ordered include:

1.  Echocardiogram.
2. Electrocardiogram.
3. Abdominal ultrasound.
4. Cardiac ultrasound.
5. Heart MRI.
6. CT scan.
7. Chest X-ray.
8. Angiography.
9. Ankle-brachial index.

 

 Treatment and Management

How is artherosclerosis treated?

Treatment according to stage:

• Cholesterol lowering drugs, blood pressure control, lifestyle changes such as consuming a healthy diet and frequently exercising.
• Medications to regulate cholesterol levels and control blood pressure. Medical procedures such as angioplasty or stenting can also be conducted to open blocked arteries.
• Drugs to prevent blood clotting and medical procedures to remove the clot- coronary artery bypass surgery or atherectomy.
• IV-surgical procedures to restore flow of blood must be performed. They include heart transplant and coronary artery bypass surgery.

The location of the atherosclerotic plug (or the type of atherosclerosis) can be used in guiding which kind of specialist to attend to you: cardiologist (heart), vascular surgen (blood vessels), neurologist (brain and spinal cord) and nephrologist (kidneys).

 

Lifestyle modifications:

• Engage in regular physical activity.
• Embrace a healthy diet.
• Avoid consuming tobacco products.

 

Medicines

• Anti-hypertensive agents.
• Cholesterol-lowering agents.
• Medications that prevent clot formation.
• Drugs for management of blood sugar.

 

Medical procedures

• Stent replacement.
• Atherectomy.
• Angioplasty.
• Peripheral artery bypass.
• Coronary artery bypass grafting.

 

 Complications

What are the complications of artherosclerosis?

The following are complications of artherosclerosis:

1. Heart attack.
2. Stroke.
3. Coonary artery disease.
4. Arrhthmia.
5. Mesenteric ischemia.
6. Renal artery stenosis.
7. Peripheral artery disease.
8. Carotid artery disease.
9. Transcient ischemic attack.
10. Aneurysms.

 

Prevention

How do we prevent artherosclerosis?

• Atherosclerosis may be prevented by reducing risk through:

1. Maintaining a healthy weight.
2. Avoid consuming tobacco products.
3. Engage in frequent exercise such as jogging, running, weigh-lifting and walking.
4. Ensure that foods are low in saturated fat and sugar.
5. Early management of medical conditions such as hypertension.